Using Peer Mentors to Support PACT Team Efforts to Improve Diabetes Control

• Change in Glucose Control [ Time Frame: Baseline, 6 months, and 12 months ] [ Designated as safety issue: No ]
  Measured by change in HbA1c
  
  

• Blood Pressure [ Time Frame: Baseline, 6 months, 12 months ] [ Designated as safety issue: No ]
  
• Diabetes Quality of Life [ Time Frame: Baseline, 6 months, 12 months ] [ Designated as safety issue: No ]
  Diabetes Distress Scale
  
  
• Depression Symptoms [ Time Frame: Baseline, 6 months, and 12 months ] [ Designated as safety issue: No ]
  As measured by the Patient Health Questionnaire-2
  
  
• Direct LDL blood levels [ Time Frame: Baseline, 6 months, and 12 months ] [ Designated as safety issue: No ]
  

The primary objectives of this study are: (1) test the long-term effectiveness of a peer mentor model on improving glucose control in a mixed race population of poorly controlled diabetic veterans; (2) test the effectiveness of using former peer mentees as peer mentors as a means of creating a self-sustaining program; and (3) determine the cost-effectiveness of peer mentoring as implemented in this study. Secondary objectives include: (1) assess the effects of becoming a mentor on those who were originally mentees given a growing literature that being a mentor is good for your health; and (2) assess the effects of the program on other important health outcomes for diabetics including blood pressure, low density lipoprotein (LDL) levels, diabetes quality of life, and depression.

This study will be a prospective randomized controlled trial. Outcomes to be measured include glycosylated hemoglobin, direct LDL, diabetes quality of life and depression. We will also perform a cost-effectiveness analysis of the different interventions compared to the control arm. We will take the perspective of the payer.

The trial has 3 arms: 1. usual care; 2. peer mentoring where mentors are veterans who were once in poor control but are now in good control; and 3. peer mentoring where the mentoring comes from former mentees. Qualitative interviews with participants will provide an additional layer of insight. Determining how best to create sustainable peer mentoring models will create for the VA a new powerful tool with the potential for improving chronic disease outcomes and reducing disparities, and it will demonstrate VA leadership in creating models exportable to other settings.